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6. Cardiovascular System > 9. Infective Endocarditis (IE) > Flashcards

9. Infective Endocarditis (IE) Flashcards

1
Q

What is infective endocarditis (IE)?

A

Infection of the heart valves or other endocardial lined structure within the heart.

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2
Q

Name 4 types of IE.

A
  1. Left sided native IE.
  2. Left sided prosthetic IE.
  3. Right sided IE (rarely prosthetic).
  4. Device related IE e.g. pacemakers, defibrillators.
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3
Q

Which type of IE is more likely to spread systemically?

A

Left sided IE - these are more likely to cause thrombo-emboli.
(Right side IE could spread to the lungs).

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4
Q

Describe the pathogenesis of IE.

A

Microbial adherence (infection) -> vegetation on valve -> cardiac valve distortion -> cardiac failure and septic problems.

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5
Q

Name the most common causative organism in IE.

A

Streptococcus viridans

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6
Q

Give 3 risk factors for IE.

A
  1. Congenital - valve defects, VSD, PDA.
  2. Prosthetic or regurgitant valves.
  3. Intravenous drug use (IVDU).
  4. Poor dental hygiene.
  5. Soft tissue infections.
  6. Post heart surgery (If infectious material is introduced into the blood stream or during surgery).
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7
Q

Give 3 groups of people who are at risk of IE.

A
  1. Elderly.
  2. IVDU.
  3. Those with prosthetic valves.
  4. Those with rheumatic fever.
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8
Q

What bacteria are most likely to cause IE?

A
  1. Staph aureus.
  2. Staph epidermidis (coagulase negative staph).
  3. Strep viridans (alpha haemolytic).
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9
Q

Give 3 organisms (apart from Strep viridans) that can cause IE.

A

Enterococci, staph aureus/epidermidis, diphtheroids, Haemophilus, actinobacillus, Coxiella burnetii, chlamydia.

Fungi - Candida, aspergillus, histoplasma.

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10
Q

What is the hallmark of IE?

A

Vegetation - lumps of fibrin hanging off the heart valves.

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11
Q

Give 5 signs of IE.

A
  1. Splinter haemorrhages.
  2. Osler’s nodes.
  3. Janeway lesions.
  4. Roth spots.
  5. Heart murmurs.
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12
Q

Give 3 symptoms of IE.

A
  1. Signs of systemic infection e.g. fever, sweats.
  2. Embolisation e.g. stroke, PE, MI.
  3. Valve dysfunction e.g. HF, arrhythmia.
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13
Q

What is an IE patient at risk of?

A
  1. Stroke - vegetations.
  2. Destruction of valve - regurgitation - worsening heart failure.
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14
Q

Name 2 sites where vegetation is likely for IE.

A
  1. Atrial surface of AV valves.
  2. Ventricular surface of SL valves.
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15
Q

Why is it important to remove large vegetations?

A

To prevent them embolising and causing a stroke, MI etc.

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16
Q

Name the criteria that is used in the diagnosis of infective endocarditis.

A

Duke’s criteria.

17
Q

Describe the Duke criteria for the diagnosis of IE.

A

Definite IE:
1. 2 major
2. 1 major + 3 minor
3. 5 minor

2 Major Criteria:
1. Pathogen grown from blood cultures
2. Evidence of endocarditis on echo, or new valve leak

5 Minor Criteria:
1. Predisposing factors
2. Fever
3. Vascular phenomena/signs
4. Immune phenomena/signs
5. Equivocal blood cultures

18
Q

Give 2 major points in the Duke’s criteria that if present can confirm a diagnosis of IE.

A
  1. Positive blood culture with typical IE microorganism.
  2. Positive echo showing endocardial involvement.
19
Q

Give 5 minor points in the Duke’s criteria that, if present, can confirm a diagnosis of IE.

A
  1. Predisposing factors
  2. Fever
  3. Vascular phenomena/signs
  4. Immune phenomena/signs
  5. Equivocal blood cultures
20
Q

Investigations to confirm suspected infective endocarditis (IE).

A
  1. Blood cultures - essential
    - 3 sets of blood cultures, at different times and sites.
  2. Echocaardiogram - shows endocardial involvement e.g. TTE (transthoracic echo) or TOE
  3. Bloods - raised ESR/CRP.
  4. ECG.
21
Q

Why might blood cultures be negative in a person with IE?

A

They may have previously received antibiotics.

22
Q

Give 2 advantages and 1 disadvantage of a trans-thoracic echo (TTE).

A

Advantages:
1. Safe.
2. Non-invasive, no discomfort.

Disadvantage:
1. Often poor images so lower sensitivity.

23
Q

Give 1 advantage and 2 disadvantages of a trans-oesophageal echo (TOE/TEE).

A

Advantage:
1. Excellent images.

Disadvantages:
1. More invasive, discomfort.
2. Small risk of perforation or aspiration.

24
Q

Describe the treatment for IE.

A
  1. Antibiotics before results of culture
    - IV benzylpenicillin + gentamicin.
  2. Antiobiotics based on cultures
    - Tailor to cultures + sensitivity
  3. Treat any complications
    - Arrhythmia, heart failure, heart block, embolisation, stroke rehab, abscess drainage
  4. Surgery.
25
Q

Give 4 indications for surgery in IE.

A
  1. Antibiotics not working.
  2. Complications.
  3. To remove infected devices.
  4. To replace the valve.
  5. To remove large vegetations before they embolise.

6. Cardiovascular System (24 decks)

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